ArticleCardiovascular research2021
High sodium intake, glomerular hyperfiltration, and protein catabolism in patients with essential hypertension.
Article in Cardiovascular research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
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Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Early kidney damage in children and adolescents with primary arterial hypertension: a systematic review.European journal of pediatrics · 2025Pooled it
- The impact of dietary sodium and fructose on renal sodium handling and blood pressure in healthy adults.Physiological reports · 2025Trial
- Acute high-dose MitoQ does not increase urinary kidney injury markers in healthy adults: a randomized crossover trial.American journal of physiology. Renal physiology · 2024Trial
- High dietary salt intake increases urinary NGAL excretion and creatinine clearance in healthy young adults.American journal of physiology. Renal physiology · 2022Trial
- Salt and chronic kidney disease.Nature reviews. Nephrology · 2026Review
- Water intake mediates cross-sectional associations between urinary kidney injury biomarkers and race in emerging adults.American journal of physiology. Regulatory, integrative and comparative physiology · 2026Article
- Early Detection of Chronic Kidney Disease in Men Using Lifestyle and Demographic Indicators: A Machine Learning Approach for Primary Healthcare Settings.Healthcare (Basel, Switzerland) · 2026Article
- Beyond Blood Pressure: Salt Sensitivity as a Cardiorenal Phenotype-A Narrative Review.Life (Basel, Switzerland) · 2026Review
- Association of Body Mass Index Trajectories with Kidney Stone Disease: An Analysis Based on the NHANES Database.Kidney & blood pressure research · 2026Article
- Probiotic Lactobacillus rhamnosus GG Alleviates Prehypertension and Restores Gut Health and Microbiota in NaCl-Induced Prehypertensive Rats.Probiotics and antimicrobial proteins · 2026Article
- Nutrient intake and renal cancer: molecular pathways and mechanistic insights into the protective role of dietary components.Frontiers in nutrition · 2026Review
- Early renal response to long-term salt loading: mitochondrial dysfunction, ER stress, and uromodulin accumulation in the kidney medulla.American journal of physiology. Renal physiology · 2025Article
- Urinary metabolomics analysis of patients with renal tubular dysfunction after PCI surgery.International urology and nephrology · 2025Article
- Environment-Associated Variations in Blood Metabolism of Mongolian Cattle Grazing in the Alxa Desert of China.Veterinary sciences · 2025Article
- Exploration of the metabolomic mechanisms of postmenopausal hypertension induced by low estrogen state.eLife · 2025Article
- The impact of high-salt diet and diuretics on the development of the aestival phenomenon in patients with chronic heart failure.Frontiers in nutrition · 2025Article
- How PPAR-alpha mediated inflammation may affect the pathophysiology of chronic kidney disease.Current research in physiology · 2025Review
- Podocyte-targeted therapies - progress and future directions.Nature reviews. Nephrology · 2024Review
- Prediction of post-donation renal function using machine learning techniques and conventional regression models in living kidney donors.Journal of nephrology · 2024Article
- A population-based urinary and plasma metabolomics study of environmental exposure to cadmium.Environmental health and preventive medicine · 2024Article
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Authors and funding
21 authors.
Funding
Abstract
aimsA blood pressure (BP)-independent metabolic shift towards a catabolic state upon high sodium (Na+) diet, ultimately favouring body fluid preservation, has recently been described in pre-clinical controlled settings. We sought to investigate the real-life impact of high Na+ intake on measures of renal Na+/water handling and metabolic signatures, as surrogates for cardiovascular risk, in hypertensive patients. METHODS AND
resultsWe analysed clinical and biochemical data from 766 consecutive patients with essential hypertension, collected at the time of screening for secondary causes. The systematic screening protocol included 24 h urine (24 h-u-) collection on usual diet and avoidance of renin-angiotensin-aldosterone system-confounding medications. Urinary 24 h-Na+ excretion, used to define classes of Na+ intake (low ≤2.3 g/day; medium 2.3-5 g/day; high >5 g/day), was an independent predictor of glomerular filtration rate after correction for age, sex, BP, BMI, aldosterone, and potassium excretion [P = 0.001; low: 94.1 (69.9-118.8) vs. high: 127.5 (108.3-147.8) mL/min/1.73 m2]. Renal Na+ and water handling diverged, with higher fractional excretion of Na+ and lower fractional excretion of water in those with evidence of high Na+ intake [FENa: low 0.39% (0.30-0.47) vs. high 0.81% (0.73-0.98), P < 0.001; FEwater: low 1.13% (0.73-1.72) vs. high 0.89% (0.69-1.12), P = 0.015]. Despite higher FENa, these patients showed higher absolute 24 h Na+ reabsorption and higher associated tubular energy expenditure, estimated by tubular Na+/ATP stoichiometry, accordingly [Δhigh-low = 18 (12-24) kcal/day, P < 0.001]. At non-targeted liquid chromatography/mass spectrometry plasma metabolomics in an unselected subcohort (n = 67), metabolites which were more abundant in high versus low Na+ intake (P < 0.05) mostly entailed intermediates or end products of protein catabolism/urea cycle.
conclusionWhen exposed to high Na+ intake, kidneys dissociate Na+ and water handling. In hypertensive patients, this comes at the cost of higher glomerular filtration rate, increased tubular energy expenditure, and protein catabolism from endogenous (muscle) or excess exogenous (dietary) sources. Glomerular hyperfiltration and the metabolic shift may have broad implications on global cardiovascular risk independent of BP.
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